Individual provider Active NPI

Jennifer Kate Davis, FNP

  • Family Nurse Practitioner
  • Benzonia, MI
National Provider Identifier
1477820983
Registry record updated Feb 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704248162 Issued in MI
Practice address
6227 Frankfort Hwy
Benzonia, MI 49616-8632
Phone
(231) 882-9661
Fax
(231) 882-1049
NPI assigned
Nov 29, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 1181489 TX
Family Nurse Practitioner 363LF0000X 4704248162 MI Primary

Addresses

Primary practice location

6227 Frankfort Hwy
Benzonia, MI 49616-8632

Mailing address

6227 Frankfort Hwy
Benzonia, MI 49616-8632
Phone (231) 882-9661

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121005000432 MI Practitioner - Nurse Practitioner 5294984225 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1181489TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Crystal Lake Clinic P.C. CurrentSince Sep 1, 2012 Accepting new patients
Crystal Lake Clinic PC Current Accepting new patients
Crystal Lake Clinic P.C. CurrentSince Sep 1, 2012 Accepting new patients
Crystal Lake Clinic P.C. Past Accepting new patients
Crystal Lake Clinic P.C. Past Accepting new patients

Locations

6227 Frankfort Hwy
Benzonia, MI 49616
Phone (231) 882-9661

124 Ames St
Elk Rapids, MI 49629
Phone (231) 264-8282

93 W Fourth St
Ste B
Suttons Bay, MI 49682
Phone (231) 271-5990

4025 Chums Village Dr
Traverse City, MI 49685
Phone (231) 252-3433

Interoperability endpoints

  • Direct secure messaging: jgilbert103522@direct.covenanthealthcare.com
  • Direct secure messaging: jenniferdavis@clhcmi.allscriptsdirect.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1322524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738540800000",
    "number": "1477820983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6227 FRANKFORT HWY",
            "city": "BENZONIA",
            "state": "MI",
            "postal_code": "496168632",
            "telephone_number": "231-882-9661",
            "fax_number": "231-882-1049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6227 FRANKFORT HWY",
            "city": "BENZONIA",
            "state": "MI",
            "postal_code": "496168632",
            "telephone_number": "231-882-9661",
            "fax_number": "231-882-1049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JENNIFER",
        "middle_name": "KATE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-29",
        "last_updated": "2025-02-03",
        "certification_date": "2025-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "1181489",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704248162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Benzonia, MI

Sources for this page

Verify at the official NPI Registry.